User:Spirit&Opportunity/sandbox

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Practice Editing Here (Nov 23rd in-class Wiki session work)

 * This is a place to practice clicking the "edit" button and practice adding references (via the citation button).
 * Cirrhosis

Assignment # 3

 * Proposed changes:
 * 1. The article explains that hepatic encephalopathy (HE) was previously treated via a low-protein diet because theoretically the nitrogen balance would need to be lowered in patients impacted by high levels of ammonia. The article cites an outdated article to support this theoretical extrapolation. I wish to replace this theoretical argument with a different clinical observation mentioned in the practice guideline as informing the decision to previously adopt low-protein diets.
 * 2. I will include one situation in which low-protein diets would be indicated in patients with HE.
 * 3. I will add the guideline that normal protein intake is recommended on par with general cirrhosis treatment guidelines.
 * Rationale for proposed changes:
 * 1. The current nitrogen balance argument is based on an outdated 2009 paper by Sundaram V & Obaid S which explains the theoretical effects of nitrogen on HE. The Wikipedia entry extrapolates this argument for why low-protein diets were widely used. The recent 2019 clinical practice guideline by The European Association for the Study of the Liver connects the previous clinical decision of physicians to prescribe low protein diets to uncontrolled studies which demonstrated increased mental status in HE patients with portosystemic shunts. I decided to proceed with the clinically demonstrated justification of the low-protein diet.
 * 2. Low-protein diets are indicated for short term use in people with severe, acute HE and gastrointestinal bleeding. It is important to include this information in order to demonstrate that severe HE could be impacted by normal to high protein intake.
 * 3. I will include this change because it demonstrates that hepatic encephalopathy - a complication of cirrhosis - can be treated using the same intervention as cirrhosis itself.
 * Critique of source:
 * Firstly, one author (Parés A) reports receiving grants, personal fees and other from Intercept Pharmaceuticals, other from Novartis, and personal fees from Cymabay Therapeutics, Inc.. Another author, who is also the Clinical Practice Guideline Panel's Chair, (Merli M) reports receiving personal fees from Kedrion. These conflicts are concerning as they may bias the recommendations towards these companies' interests.
 * In addition, grey literature was not explicitly searched which increases the plausibility of publication bias. No Funnel Plot was demonstrated to assess the likelihood of publication bias.
 * However I still believe source can be used as all recommendations were peer reviewed by external experts and the EASL Governing Board. Recommendations were also assessed using GRADE and every score was reported alongside each recommendation. I believe that these processes help mitigate the potential biases brought on by the above two points and therefore I am comfortable using this guideline to inform this Wikipedia edit.
 * Talk page entry:
 * In the WP:Cirrhosis#Complications Hepatic Encephalopathy section, reference #55 is outdated and cited to explain why nitrogen balance theoretically justified the use of a low protein diet. We found a 2019 practice guideline which better fits WP:MEDRS as a clinical practice guideline and systematic review which directly links study findings to a clinical decision. We propose removing "High-protein food increases the nitrogen balance, and would theoretically increase hepatic encephalopathy; in the past, a low-protein diet was recommended. Recent studies show that this assumption was incorrect, and high-protein foods are even encouraged to maintain adequate nutrition.". We propose replacing it with "Past treatment of hepatic encephalopathy included a low-protein diet. It was thought that this diet could help improve the mental status of people with hepatic encephalopathy and portosystemic shunts. However, a low protein diet is no longer recommended because it can cause nutritional deficiencies in people with hepatic encephalopathy."
 * In the same section and based on the same guideline, we wish to add: "Protein uptake is now encouraged to at least match general recommendations for cirrhosis."
 * In the same section and based on the same guideline, we wish to add: “A low protein diet is only recommended for short term use in people with severe hepatic encephalopathy and gastrointestinal bleeding. " Spirit&#38;Opportunity (talk) 23:53, 3 December 2020 (UTC)
 * In the same section and based on the same guideline, we wish to add: “A low protein diet is only recommended for short term use in people with severe hepatic encephalopathy and gastrointestinal bleeding. " Spirit&#38;Opportunity (talk) 23:53, 3 December 2020 (UTC)

What to post on the Wikipedia article talk page?

 * This will also be covered on Nov 23rd in class. Your group should use the below template to share an outline of your proposed improvements (including your new wording and citations). Article talk pages are not places to share your assignment answers. The Wikipedia community will be more interested in viewing your exact article improvement suggestions including where you plan to improve the article (which section), what wording you suggest, and the exact citation (Note: all citations must meet WP:MEDRS)
 * You will not be able to paste citations directly from your sandbox to talk pages (unless you are interested in editing/learning Wiki-code in the "source editing" mode). We suggest re-adding your citations on the talk page manually (using the cite button and populating the citation by pasting in the DOI, website, or PMID). You will have to repeat this process yet again when you edit the actual article live.
 * Talk Page Template: CARL Medical Editing Initiative/Fall 2020/Talk Page Template